Effects of Physical Therapy Management on Gross Motor Function and Spasticity among Diplegic Cerebral Palsy

Hamza  Ahmed; Muhammad  Abid Khan; Syed Meeran  Hasnain; Raman  Kumar; Fouzia  Hussain

doi:10.18502/jmr.v19i3.19083

Hamza Ahmed Department of Physical Therapy, Faculty of Allied Health Sciences, Ziauddin College of Physical Therapy, Ziauddin University, Karachi, Pakistan.
Muhammad Abid Khan Department of Physical Therapy, Faculty of Allied Health Sciences, Ziauddin College of Physical Therapy, Ziauddin University, Karachi, Pakistan.
Syed Meeran Hasnain Department of Physical Therapy, Faculty of Allied Health Sciences, Ziauddin College of Physical Therapy, Ziauddin University, Karachi, Pakistan.
Raman Kumar Liaquat National Hospital and Medical College, Karachi, Pakistan.
Fouzia Hussain Department of Physical Therapy, Faculty of Allied Health Sciences, Ziauddin College of Physical Therapy, Ziauddin University, Karachi, Pakistan.

DOI: https://doi.org/10.18502/jmr.v19i3.19083

Keywords: Diplegic cerebral palsy, Spasticity, Hippotherapy, Myofascial release, Gross motor function

Abstract

Introduction: Cerebral palsy (CP) is a leading cause of disability among the pediatric population, especially in Asia. Permanent disability is mostly due to spasticity and poor gross motor function, which adds a significant socioeconomic burden to the healthcare system. This study aims to evaluate the effectiveness of physical therapy-based interventions in improving gross motor function and reducing spasticity.

Materials and Methods: From February to July 2024, a thorough search was conducted on CINAHL, PubMed, PEDro, Web of Science and Scopus for studies assessing spasticity using the modified Ashworth scale (MAS) and gross motor function using the gross motor function measure (GMFM)-88 standing/walking dimensions in children with diplegic CP. Seventeen eligible trials were analyzed using fixed/random-effects models in MedCalc.

Results: The analysis showed significant improvements in walking ability P<0.0001 (confidence interval [CI] 95%, 0.20%, 0.50%], standardized mean differences [SMD]=0.563, Q=43.9325) and standing ability P=0.0004 (CI 95%, 0.20%, 0.50%,SMD=0.187, Q=22.5239) in the experimental group (EG), as measured using the GMFM-88. However, no significant impact was observed on any dimension of the GMFM-88 P=0.5821 (CI 95%, -0.0508%, 0.301%, SMD=0.125, Q=6.5843). According to the MAS, interventions targeting spasticity reduction showed no significant effects P=0.1018 (CI 95%, 0.20%, 0.50%, SMD=0.306, Q=10.5922).

Conclusion: This meta-analysis reveals that modified suit therapy, vibration therapy, and hippotherapy enhance standing and walking in GMFM-88 but did not reveal significant effects of physical therapy interventions in improving overall gross motor function or reducing spasticity in children with diplegic CP.